Provider Demographics
NPI:1225019631
Name:FULTON, BRIAN (MSPT)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:FULTON
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 DELAVERGNE AVE
Mailing Address - Street 2:C/O CENTER FOR PHYSICAL THERAPY
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-1202
Mailing Address - Country:US
Mailing Address - Phone:845-297-4789
Mailing Address - Fax:845-297-8596
Practice Address - Street 1:2 DELAVERGNE AVE
Practice Address - Street 2:C/O CENTER FOR PHYSICAL THERAPY
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-1202
Practice Address - Country:US
Practice Address - Phone:845-297-4789
Practice Address - Fax:845-297-8596
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026214225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
10086264OtherCDPHP
837295OtherMANAGED PHYSICAL NETWORK
000409356001OtherHEALTH NOW
7998596OtherAETNA PPO
2223675OtherCCN
P3308238OtherOXFORD
2436962OtherUNITED HEALTH CARE
4126154OtherMVP
100093OtherOPERATING ENGNRS LCL 825
3575347OtherAETNA HMO
NYQ11J7OtherBLUE CROSS BLUE SHIELD
100093OtherOPERATING ENGNRS LCL 825